Cataracts: Difference between revisions

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==Background==
==Background==
 
[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
* A cataract is opacification in the lens of one or both eyes which can lead to decreased visual acuity and visual distortions
*Opacification of the lens of one or both eyes, which can lead to decreased visual acuity and visual distortions
* Cataracts are most commonly due to normal age related changes, however they can also be caused by eye trauma, exposure to sunlight or radiation, malnutrition, corticosteroid use, and other pathologic processes
*Most commonly due to normal age related changes, however they can also be caused by [[eye trauma]], exposure to sunlight or radiation, malnutrition, corticosteroid use, and other pathologic processes
* By age 80 approximately 50% of Americans have been diagnosed with one or more cataracts<sup>[1]</sup>
*By age 80, approximately 50% of Americans have been diagnosed with one or more cataracts<ref>National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020</ref>
* Additional risk factors for cataract include Diabetes, smoking, prolonged exposure to sunlight, and alcohol use<sup>[1]</sup> [2]  
*Additional risk factors for cataract include diabetes, smoking, prolonged exposure to sunlight, and alcohol use<ref>National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020</ref><ref>West SK, and Valmadrid CT, "Epidemiology of risk factors for age-related cataract," Surv Ophthalmol. 1995;39(4):323.</ref>
*Typically a non-emergent pathology and can be managed with outpatient ophthalmologic surgery on a routine basis.
**With the exception of traumatic cataract, [[vision loss]] from cataract is typically ''not'' acute; rather, develops over the course of months to years.


==Clinical Features==
==Clinical Features==
 
[[File:Dense white mature cataract.jpg|thumb|right|The appearance of a dense, white cataract in a 60 year-old male. ]]
*Vision loss typically not acute but develops over months to years (unless traumatic cataract)
=== History ===
=== History ===
* Cloudy or blurry vision
* Cloudy or blurry vision
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* Colors appear faded
* Colors appear faded
* Appearance of a halo around bright lights
* Appearance of a halo around bright lights
* +/- Recent trauma to the eye
=== Exam Findings ===
* Lens opacity
* Darkening of red reflex
* Decreased visual acuity


==Differential Diagnosis==
==Differential Diagnosis==
{{Acute vision loss noninflamed DDX}}
===Subacute Vision Loss (Noninflamed)===
* Cataracts
* Congenital blindness
* Diabetic retinopathy


{{Eye trauma}}
{{Unilateral red eye DDX}}


==Evaluation==
==Evaluation==
===Workup===
*Typically diagnosed clinically by the finding of lens opacity on direct ophthalmic exam
 
**Precise classification (nuclear, cortical, posterior sub-capsular) may be done by ophthalmologist
===Diagnosis===
*If the patient has risk factors for diabetes or HIV/AIDS, consider appropriate diagnostic tests


==Management==
==Management==
 
*Definitive treatment is (typically outpatient, non-emergent) surgery, wherein clouded lens is removed and replaced with clear, artificial lens
*Other supportive care modalities that help with visual symptoms include:<ref>National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020</ref>
* Using brighter lights while at work or at home
* A trial of anti-glare sunglasses for outdoor activities
* Using magnifying lens glasses for reading and other daily


==Disposition==
==Disposition==
 
*Discharge with optho follow up


==See Also==
==See Also==
 
*[[Acute Vision Loss (Noninflamed)]]
*[[Orbital trauma]]
*[[Unilateral red eye]]


==External Links==
==External Links==
https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts
*https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts
*https://www.aao.org/young-ophthalmologists/yo-info/article/how-to-conduct-eight-point-ophthalmology-exam


==References==
==References==
<references/>
<references/>
[1] https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts
 
[2] West SK, and Valmadrid CT. "Epidemiology of risk factors for age-related cataract," Surv Ophthalmol. 1995;39(4):323.
[[Category:Ophthalmology]]

Latest revision as of 15:57, 8 February 2021

Background

Eye anatomy.
  • Opacification of the lens of one or both eyes, which can lead to decreased visual acuity and visual distortions
  • Most commonly due to normal age related changes, however they can also be caused by eye trauma, exposure to sunlight or radiation, malnutrition, corticosteroid use, and other pathologic processes
  • By age 80, approximately 50% of Americans have been diagnosed with one or more cataracts[1]
  • Additional risk factors for cataract include diabetes, smoking, prolonged exposure to sunlight, and alcohol use[2][3]
  • Typically a non-emergent pathology and can be managed with outpatient ophthalmologic surgery on a routine basis.
    • With the exception of traumatic cataract, vision loss from cataract is typically not acute; rather, develops over the course of months to years.

Clinical Features

The appearance of a dense, white cataract in a 60 year-old male.
  • Vision loss typically not acute but develops over months to years (unless traumatic cataract)

History

  • Cloudy or blurry vision
  • Difficulty with night time vision
  • Colors appear faded
  • Appearance of a halo around bright lights
  • +/- Recent trauma to the eye

Exam Findings

  • Lens opacity
  • Darkening of red reflex
  • Decreased visual acuity

Differential Diagnosis

Acute Vision Loss (Noninflamed)

†Emergent Diagnosis

Subacute Vision Loss (Noninflamed)

  • Cataracts
  • Congenital blindness
  • Diabetic retinopathy

Orbital trauma

Acute

Subacute/Delayed

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Evaluation

  • Typically diagnosed clinically by the finding of lens opacity on direct ophthalmic exam
    • Precise classification (nuclear, cortical, posterior sub-capsular) may be done by ophthalmologist
  • If the patient has risk factors for diabetes or HIV/AIDS, consider appropriate diagnostic tests

Management

  • Definitive treatment is (typically outpatient, non-emergent) surgery, wherein clouded lens is removed and replaced with clear, artificial lens
  • Other supportive care modalities that help with visual symptoms include:[4]
  • Using brighter lights while at work or at home
  • A trial of anti-glare sunglasses for outdoor activities
  • Using magnifying lens glasses for reading and other daily

Disposition

  • Discharge with optho follow up

See Also

External Links

References

  1. ↑ National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020
  2. ↑ National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020
  3. ↑ West SK, and Valmadrid CT, "Epidemiology of risk factors for age-related cataract," Surv Ophthalmol. 1995;39(4):323.
  4. ↑ National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020
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